加味温胆汤联合耳穴压豆治疗痰湿壅盛型高血压的临床观察

Clinical Observation of Modified Wendan Decoction Combined with Auricular Point Seed-pressing in Treatment of Hypertension with Excessive Accumulation of Phlegm-Damp Syndrome

【目的】观察加味温胆汤联合耳穴压豆治疗痰湿壅盛型高血压患者的临床疗效。【方法】将116例痰湿壅盛型高血压患者随机分为观察组和对照组,每组各58例,2组患者均给予常规检查与健康宣教,对照组给予硝苯地平控释片口服治疗,观察组在对照组治疗的基础上给予口服加味温胆汤联合耳穴压豆治疗。2组均连续治疗6周。治疗6周后,评价2组临床疗效,观察2组患者治疗前后血清人软骨糖蛋白-39(YKL-40)与人纤维胶凝蛋白3(ficolin-3)表达的变化情况,以及中医证候积分的变化情况。比较2组患者治疗前后动态血压及血压变异性的变化情况,包括24 h平均收缩压(24 h SBP)、24 h平均舒张压(24 h DBP)、24 h平均舒张压变异性(24 h DBPV)和24 h平均收缩压变异性(24 h SBPV)。并评价2组的安全性及并发症的发生情况。【结果】(1)治疗后,2组患者的血清YKL-40、ficolin-3水平均明显改善(P<0.05),且观察组在改善血清YKL-40、ficolin-3水平方面均明显优于对照组,差异均有统计学意义(P<0.05)。(2)治疗后,2组患者的中医证候积分均明显改善(P<0.05),且观察组在改善中医证候积分方面明显优于对照组,差异有统计学意义(P<0.05)。(3)治疗后,2组患者的24 h SBP、24 h DBP、24 h DBPV与24 h SBPV均明显改善(P<0.05),且观察组在改善24 h SBP、24 h DBP、24 h DBPV与24 h SBPV方面均明显优于对照组,差异均有统计学意义(P<0.05)。(4)观察组总有效率为94.83%(55/58),对照组为82.76%(48/58)。观察组疗效优于对照组,差异有统计学意义(P<0.05)。(5)观察组并发症总发生率为8.62%(5/58),对照组为6.90%(4/58)。观察组并发症总发生率稍高于对照组,但差异无统计学意义(P>0.05)。【结论】加味温胆汤联合耳穴压豆治疗痰湿壅盛型高血压,能够明显地改善患者血压变异性,降低血清YKL-40、ficolin-3水平,改善患者的临床症状,临床疗效显著。

Objective To observe the clinical effect of modified Wendan Decoction combined with auricular point seed-pressing in the treatment of hypertension with accumulation of excessive phlegm-damp. Methods A total of116 patients of hypertension with accumulation of excessive phlegm-damp syndrome were randomly divided into the observation group and the control group,58 patients in each group. Both groups were given routine examination and health education, the control group was given oral use of Nifedipine controlled release tablets, while the observation group was given oral use of modified Wendan Decoction combined with auricular point seed-pressing on the basis of the control group. Both groups were treated for 6 consecutive weeks. After 6 weeks of treatment,the clinical efficacy of the two groups was evaluated, and the changes of serum human chondroglycoprotein-39(YKL-40)and human fibrin gelling protein 3(ficolin-3),as well as the changes of traditional Chinese medicine(TCM)syndrome scores were observed before and after treatment. The changes of ambulate blood pressure and blood pressure variability between two groups were compared before and after treatment,including 24-h mean systolic blood pressure(24-h SBP),24-h mean diastolic blood pressure(24-h DBP),24-h mean diastolic blood pressure variability(24-h DBPV)and 24-h mean systolic blood pressure variability(24-h SBPV). The safety and the occurrence of complications of the two groups were evaluated. Results(1)After treatment, the levels of serum YKL-40 and ficolin-3 in the two groups were significantly improved(P < 0.05), and the observation group was significantly superior to the control group in improving the levels of serum YKL-40 and ficolin-3, the difference being statistically significant(P < 0.05).(2)After treatment,the TCM syndrome scores of the two groups were significantly improved(P < 0.05), and the observation group was significantly superior to the control group in improving TCM syndrome scores,the difference being statistically significant(P <0.05).(3)After treatment, 24-h SBP, 24-h DBP, 24-h DBPV and 24-h SBPV in the two groups were significantly improved(P < 0.05),and the observation group was significantly superior to the control group in improving 24-h SBP,24-h DBP,24-h DBPV and 24-h SBPV,the difference being statistically significant(P <0.05).(4)The total effective rate was 94.83%(55/58)in the observation group and 82.76%(48/58)in the control group. The effect of the observation group was superior to that of the control group,the difference being statistically significant(P < 0.05).(5)The total incidence of complications was 8.62%(5/58)in the observation group and6.90%(4/58)in the control group. The total incidence of complications in the observation group was slightly higher than that in the control group,whereas the difference being insignificant(P > 0.05). Conclusion Modified Wendan Decoction combined with auricular point seed-pressing therapy can significantly improve the blood pressure variability,reduce the levels of serum YKL-40 and ficolin-3,and improve the clinical symptoms with significant clinical effect in treating patients of hypertension with accumulation of excessive phlegm-damp syndrome.